Provider Demographics
NPI:1962706721
Name:SOUTH BROWARD HOSPITAL DISTRICT
Entity type:Organization
Organization Name:SOUTH BROWARD HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO MEMORIAL PHYSICIAN GROUP & MPC
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-265-6677
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:MPG DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 520
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5431
Practice Address - Country:US
Practice Address - Phone:954-265-2423
Practice Address - Fax:954-961-4860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BROWARD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009173523Medicaid
FL108351337Medicaid
FL038184535Medicaid